A Quick Guide to Improving Medicaid Coverage for Supportive Housing Services

The U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE) has published two reports on using Medicaid in supportive housing: Primer on Using Medicaid for People Experiencing Chronic Homelessness and Tenants in Permanent Supportive Housing, and Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices from the Field.

This Quick Guide, co-authored by CSH and the US Interagency Council on Homelessness is designed to provide a brief overview of information in these reports and other resources to help states, community health centers, behavioral health clinics, and supportive housing providers use Medicaid more strategically to serve people who are highly vulnerable and who need supportive housing.

Why Vigilance & Advocacy are Vital

blog by CSH President & CEO, Deb De Santis

Two recent developments have produced a wave of advocacy pushing for more supportive housing and affordable housing in general.

The first in California, where a just released independent analysis by the State Legislature indicates very high housing costs and lack of affordable options are hindering economic growth, and increasing poverty and homelessness there.

California has some of the most expensive housing in the country. The average home price is about 2½ times the national norm, while the average monthly rent is about 50% higher. Rents are increasing across the state while incomes are decreasing.

We know the largest cause of homelessness is the inability of people living in poverty to afford housing. Nothing bares this fact out more than the crisis in California.

Over 114,000 Californians are homeless on any given night. With 28,200 Californians experiencing chronic homelessness, California has the highest number of chronically homeless families and individuals in the nation.

Today, those who care about individuals and families struggling with homelessness and others facing housing insecurity, gathered in Sacramento to speak out loudly for more supportive housing, access to affordable rental apartments and services addressing the needs of some of the most vulnerable people in our society.

Some residents who thrive in supportive housing joined the chorus of affordable housing supporters, meeting with legislators to share their personal stories and press for immediate action.

Organized by CSH, this kind of story sharing builds a connection between formerly homeless – now residents of supportive housing – and decision-makers.

Those who have seen their lives transformed by supportive housing are speaking up because efforts to create more affordable housing options have taken a real hit over the past four years. Cuts of 79% in major state and federal sources of housing funds – due to withering bond financing, the elimination of redevelopment agencies, and sequestration – have stopped many viable projects in their tracks.

CSH and our supportive housing resident-advocates are urging California lawmakers to endorse Assembly Speaker Toni Atkins’ package of bills to create more affordable housing in the Golden State by:

  • Establishing a “California Building Homes & Jobs Fund,” a permanent source of funding for affordable housing
  • Increasing the state’s Low Income Housing Tax Credit
  • Using a portion of existing funds to reduce recidivism through investment in housing and supports for formerly incarcerated Californians

Other key proposals championed by advocates would:

  • Incorporate “Bringing Families Home” into the State budget, providing grants to counties to house child-welfare-involved families experiencing homelessness
  • Strengthen the CalWORKS Housing Support Program

California’s current predicament should send a stark message to other parts of the nation, but not everyone seems to be getting it.

In Illinois last week, those who care about homeless individuals and families joined with providers of supportive housing (for the homeless and disabled) to warn officials of “unprecedented and costly increases” in homelessness unless they reverse plans to slash the state’s successful safety-net programs.

According to Mike Bach, Executive Director of the Supportive Housing Providers Association in Illinois, the proposed budget eliminates all funding for supportive housing services for individuals and families experiencing homelessness; withholds funds for projects to serve the mentally ill; jeopardizes housing for the most vulnerable; and discontinues or severely reduces related human services. Mike points out the cuts would reduce funding for supportive housing for those exiting homelessness by over 80%, denying homes and services not delivered by Medicaid to nearly 13,000 Illinoisans.

What concerns all of us is the reductions could drive very vulnerable people into the streets, jails, nursing homes or state institutions – expensive alternatives they have no choice but to turn to when they cannot access supportive housing. The result will be higher costs to taxpayers for emergency room visits, incarcerations and other expensive crisis response measures.

Whether it’s the housing crisis in California or the potential one in Illinois, our leaders must take action now to ensure there are more, not less, opportunities for Americans to access affordable housing and community-based services crucial to ending and preventing homelessness.

CSH Addresses Homelessness In Detroit

CSH has been enlisted to help the City of Detroit implement strategies to end veteran and chronic homelessness.

Lisa Chapman, Director of the CSH Michigan office explains the partnership this way: “We have assigned one of our staff experts, Meghan Takashima, to work directly within the City’s executive structure as a Senior Homelessness Policy Advisor to Detroit. In this role, Meghan will provide the intensive support Detroit has requested to align city policy to end veteran and chronic homelessness.”

This unique arrangement is made possible in part by a generous grant previously awarded by the McGregor Fund.

“The McGregor Fund has committed considerable resources toward ending homelessness in the City of Detroit and was very receptive to our idea to tailor their grant to embed Meghan in city government as a key voice in guiding policy decisions,” said Chapman.

3ee220cMeghan will support Detroit’s Housing and Revitalization Department in the development of Every Detroiter Counts, the Detroit strategy to end homelessness. CSH’s overall role will be to provide information on best practices in service provision for those experiencing homelessness, providing local demographic and outcome data to help inform decision making and assistance in drafting plans to address homelessness and increase supportive housing development. CSH will also assist in creating measurable goals to track outcomes and to monitor program progress for city-funded organizations serving those experiencing homelessness.

Meghan noted that one specific area of focus for the work will be veteran homelessness. “No one who has served our country should have to spend a night without a home. CSH will help the city coordinate with community partners to meet the federal timeline of ending veteran homelessness by the end of 2015, and to make homelessness rare and brief among veterans moving forward.”

Meghan also pointed out the Detroit Housing and Revitalization Department is already working closely with CSH to target 200 high-need, chronically homeless individuals, veterans and families for housing in 2015.

Inaugural Supportive Housing Institute in Missouri

CSH: The Source for Housing Solutions is excited to announce its first Missouri Supportive Housing Institute (The Institute) in collaboration with its sponsor, Missouri Foundation for Health (MFH). The Institute will address the supportive housing needs of Persons Experiencing Chronic Homelessness, Frequent Users of Emergency Services, Vulnerable Persons, and Families Experiencing Homelessness and Struggling with Multiple Barriers. The Institute is currently seeking interested supportive housing development teams- see below for details on how to apply.

This training series will help supportive housing partners learn how to navigate the complex process of developing housing with support services, and reduce the time it takes to obtain funding by improving the planning and development process.  Consideration will be given to both integrated housing (with up to 25% of the housing set aside for supportive housing) and 100% supportive housing developments.

The Institute is based on the CSH Dimensions of Quality Supportive Housing, which strives to build the capacity of the supportive and affordable housing industries to create and operate high-quality, effective and sustainable housing.


Click here to review the Request for Applications.

Click here for the Missouri Supportive Housing Institute Application.

Needs Assessment and Financial Model on Supportive Housing for Ohio

This 2014 Needs Assessment and Financial Model on Permanent Supportive Housing  for Ohio is meant to be a catalyst for continued investment and new thinking on how to finance supportive housing development, operations and services. The need for supportive housing continues if local communities want to reduce their numbers of persons and families experiencing homelessness or at risk of homelessness. The case for it continues as the state reduces its reliance upon institutional care. Overall, the need continues to create access to stable housing with services for vulnerable Ohioans leading to, recovery, health and success.

Click here to read the Needs Assessment & Financial Model on Supportive Housing for Ohio. The report includes the following topics:

  • Target Populations
  • Translating the People In Need Into a Unit Goal
  • Supportive Housing Development Strategies
  • Supportive Housing Production Plan – Cost and Potential Sources
  • CSH Recommendations

This report is a summation of CSH’s work.  CSH advances a number of recommendations, and we believe these recommendations will enable the State to expand both current supportive housing development efforts and effectively allocate resources for supportive housing for the target populations.

Liberty Village, Serving Frequent Users in Terre Haute

Liberty Village, a 30 unit supportive housing development in Terre Haute, Indiana will serve frequent users of emergency services and Veterans. Funded by capital and operational support from the Indiana Housing Community Development Authority, this development will be for both individuals and families, with a breakdown of 20 one-bedroom units, 8 two-bedroom units, and 2 three-bedroom units. This project will begin construction on February 1, 2015 with plans to open during the winter of 2016 and be fully occupied by June 15, 2016. All tenants will be offered accessible, voluntary services by staff who will engage the residents and get to know what types of supports will be helpful.

Terre-Haute-Team_1-300x200The Liberty Village development team, pictured to the left, participated in the Indiana Permanent Supportive Housing Institute sponsored by IHCDA, and received a CSH $359,000 pre-development loan. This team includes Mental Health America of Vigo County, Hamilton Center, Inc, TWG Development, LLC, and Indiana State University. Liberty Village will be the third supportive housing development for Mental Health America of Vigo county.

Under the leadership of Myra Wilkey, Mental Health America of Vigo County Executive Director, this team is an inspiration and role model to any community looking to address ending homelessness by ensuring that the most vulnerable community members are able to obtain and maintain housing.

CSH is thrilled to announce this supportive housing project and looks forward to seeing it open in 2016. Click here to read local coverage about the Liberty Village ground-breaking event.

Massachusetts Chronic Individual Homelessness Pay for Success Initiative First in Nation

Yesterday was an exciting day for the Commonwealth of Massachusetts, the Massachusetts Housing and Shelter Alliance, the United Way of Massachusetts Bay and Merrimack Valley, and Santander Bank. Even more so, it was a very exciting day for hundreds of chronically homeless people who will have their lives changed forever because forward-thinking leaders came together, collaborated, innovated and made the “Chronic Individual Homelessness Pay for Success Initiative” a reality in Massachusetts.

CSH is a national nonprofit active in 33 states and we see what is unfolding across the country. Massachusetts is on the cutting edge of efforts to end homelessness.

Groundbreaking investments such as this Pay for Success Initiative are emphasizing accountability while providing the resources to fund the housing and services we know end and prevent homelessness. Beyond the much-needed supportive housing it will create, Massachusetts will continue a transformation in the way services are delivered, away from over-reliance on crisis health and shelters and toward more permanent solutions that provide the stability people need to end their homelessness.

Supportive housing works. So much so that we have witnessed a nearly 50% decline in the number of chronically homeless individuals over the past decade as supportive housing has taken hold and proliferated.

Supportive housing is a perfect match to the Pay for Success structure. Since its beginning, supportive housing has relied on data-driven outcomes and has operated under a paradigm of delivering results and savings. In other words, it’s a good bet that this Initiative will succeed.

CSH is pleased to invest $500,000 of the combined $2.5 million dollars in private capital in the Massachusetts Chronic Individual Homelessness Pay for Success Initiative, leveraging an additional $1 million in philanthropic support for a total of $3.5 million. This Initiative complements CSH’s role as a federally-designated national provider of Pay-for-Success expertise and technical assistance.

Initiatives such as this just don’t happen. They require thought-leaders who want to work together to make a difference. Like any arrangement based on multi-millions of dollars, they require hours of painstaking negotiation and patience.

They require the extraordinary leadership and political will that have been exhibited by Governor Deval Patrick and the Commonwealth of Massachusetts.

Deb_GovPatrick_JoeFinnThey require the experience and gravitas of lead partner, the Massachusetts Housing and Shelter Alliance, an agency that has the background and know-how to guide us.

They require the commitment of philanthropic and private investors such as the United Way of Massachusetts Bay and Merrimack Valley and Santander because these organizations add the proficiency to serve as fundraising intermediaries and strong financial advisors and managers.

They require the helping hands of the experts at the Harvard Kennedy School Social Impact Bond Technical Assistance Lab who provide pro bono technical assistance to state and local governments implementing Pay for Success, and are assisting Massachusetts in developing the procurement and the data analysis strategy for this Initiative.

And, most importantly, they require a fundamental belief in the promise of supportive housing to bring our most vulnerable neighbors the stability and dignity they long for and deserve.


Patrick announces $3.5 million to reduce chronic homelessness – Boston Globe 12/8/14

A new approach to fighting homelessness – Boston Globe 12/8/14

Gov. Patrick Announces ‘Pay For Success’ Plan To Aid Homeless – CBS Boston 12/8/14

‘Social Impact Bonds’ Sought to Aid Mass. Homeless  – ABC 40  12/8/14

Governor Unveils New Plan To Reduce Homelessness – Framingham Patch 12/9/14

Patrick unveils plan to aid homeless people at Framingham event – Milford Daily News 12/8/14

Photo courtesy of  United Way of Massachusetts Bay and Merrimack Valley

Florida Hospital Pledges Millions to End Homelessness

Citing strong commitments from Orlando and Orange County and declaring “We all have a moral obligation to take a stand to end chronic homelessness,” Lars Houmann, CEO and President of Florida Hospital, announced today his healthcare organization’s $6 million pledge to address homelessness in Central Florida. Joining Houmann for the announcement was Orlando Mayor Buddy Dyer, Orange County Mayor Teresa Jacobs and Central Florida Commission on Homelessness CEO Andrae Bailey. Mayor Dyer has unveiled a goal of housing 300 of Orlando’s chronically homeless individuals in three years.

Through his efforts, Orlando has earmarked $4 million to support a “Housing First” model and engaged CSH to provide technical assistance. In addition, Mayor Jacobs is leading Orange County’s plan to invest more than $15 million over the next three years for homeless housing, prevention and related family programs. The resources from Florida Hospital will serve as the kick-off investment in the Central Florida Foundation’s new “Impact Homeless Fund,” a collaborative, public and private investment-solutions vehicle to help those facing homelessness in Orange, Osceola, and Seminole Counties.

Another early focus of this funding partnership will be homeless veterans. “The local VA has had great success in working with homeless veterans in our region, but we need to work with them to improve our coordinated access practices to ensure rapid and full utilization of new housing options for those chronically homeless veterans who remain on streets; especially those who are medically fragile,” said John Hillenmeyer, managing chair of Central Florida Commission on Homelessness.

Related Resources

Press Release

Orlando Sentinel Coverage

Houston Hosts Central Florida Business & Government Leaders for Knowledge Exchange 

Opening Doors for Veterans in Rhode Island

On Monday, November 10 Operation Stand Down RI and Rhode Island Housing will celebrate the opening of the Pierce Street Apartments in Westerly, Rhode Island.  This development is the first to provide permanent supportive housing for veterans in the area. Federal, state and local leaders, funding and community partners, supportive housing providers, affordable housing developers and members of the homeless community are expected to attend the ribbon cutting ceremony.

This 10 unit supportive housing project provides veterans with on-site services that are client centered and include employment and training opportunities.  These new homes will assist the state in meeting its goal under the Opening Doors RI plan to end veterans homelessness in Rhode Island. CSH provided a $272,000 pre-development loan along with technical assistance in support of this tremendous project. 

Click here for local coverage of this great event.

CSH Partners with White Lilac for Magical Evening at Star Apartments

CSH hosted a Face To Face dinner for our Social Innovation Fund (SIF) grantees and the residents of the Star Apartments in Los Angeles, a Skid Row Housing Trust development, on October 23. CSH’s SIF grantees were on the West Coast marking the 3rd year of the national initiative, which provides supportive housing and care coordination to medically vulnerable homeless individuals in Los Angeles, San Francisco, Washtenaw County, Michigan, and Connecticut.

SIF grantees mingled with those now living at the Star, some of the most vulnerable people of Los Angeles County, including chronically homeless individuals and those with a history of frequently utilizing emergency medical services.

The Star Apartments and SIF are receiving national attention. In addition to residential tenants, the newly renovated Star is home to the offices of the Los Angeles County Department of Health Services‘ Housing for Health division headquarters.

At the dinner last month, guests were treated to the magnificent view from the Star Apartments’ garden terrace as they enjoyed a sumptuous and diverse menu of Mexican/Latina fare provided by Homegirl Cafe & Catering in stunning surroundings designed by White Lilac, Inc.


CSH is grateful to Homegirl and Sunny Ravanbach and her team at White Lilac for their generosity, and efforts that went above and beyond to “wow” our guests. Their good work ensured that the residents of the Star Apartments and SIF grantees from across the country experienced a magical evening that will be remembered for years to come.